Moderate
Bisoprolol × Digoxin
Selective beta-adrenergic blockers×Cardiac glycosides (digitalis)
Mechanism
Additive bradycardia and atrioventricular (AV) conduction slowing. Used in atrial fibrillation and heart failure for ventricular rate control.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
Standard regimen for atrial fibrillation with rapid ventricular response and heart failure. Check pulse and ECG at 1 and 4 weeks. If pulse drops below 50/min or second-degree AV block appears, adjust dose.
Sources
- ESC: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– Eur Heart J 2021;42(36):3599–3726